Lots of controversy (and opinions) over the decision to allow Zach Bell to race the LCQ and main event after a huge crash in his Dallas heat race. Due to patient-doctor confidentiality laws, no one on the Asterisk Medical Team is allowed to comment specifically on the Bell situation. However, we are able to talk about the staff’s concussion testing procedures in general, and you can then see how a rider in Bell’s situation would be treated. We spoke with Eddie Casillas, a long time member of that medic crew, about this.

Racer X: Hi, Eddie. First, let’s start by explaining your background.Eddie Casillas: My educational background is, I have a degree in sports injury management, and in my profession, I am a certified, licensed athletic trainer. Athletic trainers are not personal trainers, they’re healthcare professionals—they’re well educated in on-site trauma management. We’re also educated in rehab, conditioning and anything that involves sports and the human body. And for me, I spent three years as an army medic. So, I consider myself to have a pretty well rounded background, so I can handle whatever we see at the track.

And in the sport specifically, you’ve been around a long time in this gig, as well as working with riders away from the track.Yeah, since we started this Asterisk program 10 years ago, I’ve only missed three races, supercross or motocross, and of all of those races, I can tell you I’m the first person to get to a downed rider in a pretty large percentage of the cases.

So, you’ve come upon a lot of riders who are unconscious when you get to them—and you’ve also seen a lot of riders get back up from some huge crashes. I know legally you can’t discuss the Zach Bell situation specifically, but just in general, give us an idea of what you do when you get to a rider who has hit the ground hard.Well, hopefully you can see the crash develop. Sometimes we know what parts of the track are hot spots, sometimes you just hear the radio say “rider down” and you get over there as quickly as you can. Right away, you’re already creating something in your head to put a plan of action in place.

Casillas is a certified, licensed athletic trainer.Simon Cudby photo

And the rule is that if a rider is knocked unconscious, he’s not allowed to race that night?Yes, that is the rule. If a rider is knocked out, they’re unconscious, snoring, eyes are closed, however you want to say it, they are out of the event.

But that is determined when you get to them?Yes, and I’ll give you some scenarios. We’ve gotten to riders, and their eyes are open, they’re awake, they respond to stimulation, they know exactly what happened. We’ve had guys who are lying on the ground, their eyes are closed, but as soon as you get to them, they open their eyes and start moving around. We’ve gotten to some riders and we’re yelling at them, we’re telling them to wake up, and they’re not responding. We deal with a variety of situations.

I’ve heard people say that some riders, through all the crashes they’ve had as an amateur and at local races, can rehearse answers and tell you what you need to hear.I’ve had riders tell me they practice what they’re going to say when they see a medical person—not just our team, but from their amateur days. They say they’re going to say their name, their birthdate, whatever it is. And you can tell when a person is doing that. You can tell if they’re coherent—you start asking different questions, you start probing for more.

But, you’re not going to be there the moment they hit the ground, there will always be a small delay.[Laughs] Unless they land on me physically! Really, unless they had a camera inside their helmet monitoring their face so you could see their eyes the whole time, realistically, no. The fastest you could possibly be to someone is five or six seconds.

And you don’t mean a TV camera—you mean a camera aimed directly at their face?Right. We don’t have that. For the most part, I’m just seeing what they’re seeing.

Okay, so you’re not going to truly see them for at least five or six seconds. What’s the procedure from that point?There’s a step that we follow. You have to determine if there are injuries like cervical spine injuries, a fracture, a hip injury, airway management, or anything that would require other care. Assuming that’s clear, and all we’re worried about is the rider’s cognitive state, we have a procedure we follow. If we think a rider might have a concussion—and we’re not saying that they do, we just say, “We think this rider might have a concussion.” Because we have a protocol we have to follow that’s going to help us make a better decision on whether they have a concussion or not. If I get to a rider and he’s out, he’s not responding, then he’s out, he can’t race. If I get to a rider and his eyes are open, and he’s not unconscious, then we have to go through the procedure to determine if he can race or not.

Casillas helps Ken Roczen off the track in Phoenix in 2011.GuyB photo

And what is that test?We have a baseline test that every rider has to take. In the event that we find the rider did have a concussion at the race, then we require them to take the ImPACT test and pass that before they can return to the races. If we’re trying to determine if the rider had a concussion at the event in the first place, we use what is called the SCAT 2 test. They are taken into our rig—by themselves, parents are not allowed to come with them—and we test memory, short and long term, balance, coordination. We have a minimum score they have to reach in order for us to have confidence that they can race or not.

And you have confidence that this test is hard to pass?What it does is, if they reach the score we have as a cutoff, it’s giving us more assurance that they’re not going to put themselves at risk going back out there. But it doesn’t stop. The doctors don’t look at a test score and say, “He passed it, he doesn’t have a concussion. Go ahead and ride.” We converse with the athlete, we converse with the team, the parents, and we tell them we have a positive feeling. But look, in supercross, you’re operating at 90 percent of maximum heart rate, so if that situation results in a problem, and we see something wrong, we say, “Look, we’ll black flag you.” We try to put it on the athlete to say, “If you don’t feel right, pull off.” But we know the riders. They’re not going to do that. So if we determine they’re not riding as a coherent person should be riding, we’ll pull them off.

And every crash and rider is treated the same?If we believe a rider may have a concussion, they must take the test. And remember, it’s not like they take the test and we just let them go. We’ve had riders pass the test, and we still don’t let them ride—we just had a gut feeling. We’ve had guys who were borderline with the test. Remember, there’s a balance and coordination part of the test, and let’s say they have an ankle injury or knee injury, we have to factor that in, too. So if he scores really well in the other portions of the test, we may choose to let him ride.

On the other side of it, why not just say, “We saw the crash, we saw how hard you hit, just from looking at it, we know you shouldn’t ride.” Why not just make a call like that?Because that’s not the right thing to do. We like to use what’s available to us to make a better decision to determine if that rider has a concussion. These tests help us do that—they’re tools. You could see a crash and say, “That was bad, you probably broke your leg.” But you won’t know until you take an X-ray.

So, this is like taking an X-ray to determine if you have a broken bone.Yes. It allows us to make a decision. And these tests are always evolving; they’re always analyzing the data from other sports, any sport that uses the ImPACT test, for example, to determine if things need to change.

Now, the ImPACT test, that’s what you would use later to determine if a rider who had a concussion could come back to racing the next week. That’s used in other sports. The SCAT 2 test which you use at the track is, as well?Yes. Some people only use the SCAT 2, and some people only use the ImPACT test. But when the Asterisk Medical Crew decided to do that in this sport, I was personally left responsible for looking through the data and coming up with a program, then the doctors looked at that and signed off on it. When I looked at all of the programs, I tried to take the best pieces from each one, and put it together for our program. I think it’s the best program possible to make the best decisions.

And this would measure up in other athletic competitions.Yes. Some professional sports just use the ImPACT test, some college programs might only use SCAT 2, some don’t use anything. I look at what you need to be competitive in this sport—I know where you heart rate is when you’re on a bike, I know what you have to do, physically, to stay on a bike. This sport is tough, so I wanted to make this program tougher than others.

The ImPACT test is totally different?That’s the computerized software program that looks into short and long term memory, reaction time, things like that.

Casillas has been with Asterisk since the start of the program 10 years ago.Simon Cudby photo

Everyone is different. Is it possible that a concussion could affect some riders differently than others, and some riders with a concussion might respond better to these tests? Can some people maybe just pull this off even with a concussion?No. And that’s why we do the baseline testing. And that test even has instruments in it to determine if someone is trying to tank their score. We also redo the test every two years.

I know you guys are stuck in a tough situation. Sometimes, people will say you should just always air far on the side of caution. But you have a need to backup what you say.Yes, and on both ends of the spectrum. There is a side of this to where there is a lot of money at stake. Some of these guys might be competing for a championship, or some of them might be doing this race to make a living. We understand that it’s an athletic competition, and we don’t want to stop the athlete from competing if he can. But we also don’t want you, ten years from now, lashing out at your wife because you have a traumatic brain injury. With what’s going on in other sports, we really wanted to use that as a means to get this going as soon as possible. What people have to understand is, everyone on the Asterisk Medical Crew, we have jobs during the week. And if we make a bad decision at the races, we could lose our license. So if we don’t have anything in place, if we don’t have a test, we could be just pulling riders out of the races and costing them money or a championship when they actually might have been okay to race. And on the other side, if we let a rider race, and we don’t have a good program in place to have made that decision, then they could take us to court, or we could lose our license. So that’s why we push for this.

Anything I missed?When you look at moto being such a small sport, I think our baseline program is the first in any motorsport. I mean, NASCAR, they don’t even have a mandatory concussion program, they have a voluntary one. We’re ahead of the curve. In the NFL, they’re still having a hard time with athletes and coaches and medical staff, there’s a struggle in there with regards to that. In moto, the rules now dictate that the medical officer has the complete authority to determine if a rider can ride or not.

There is no overriding these rules by parents or teams?Absolutely not. Not by other race officials, AMA, promoters, anyone.